2017 Hemophilia State Comprehensive Care Meeting(ABD) Medicaid. Low-Income Medicaid (LIM) Also known...

Advocacy And Medicaid Updates

By

Nichelle Sims, J.D. and Jeff Cornett, RN MSN

2017 Hemophilia State Comprehensive Care Meeting

Hemophilia Advisory Board

Created by law in 2011

Members of the Board: HTC Person with hemophilia Person with a bleeding disorder other than hemophilia Caregiver of person with a bleeding disorder Advocate

Board updates Hemophilia Standards of Care and submits to Governor annually

Bleeding Disorder Advocacy Program

Hemophilia of Georgia Day at the Capitol

Senator Dean Burke read SR 280 designating February 23, 2017 as Hemophilia of Georgia Day at the Capitol

Legislation We Support

Surprise Billing SB8 – Renee Unterman HB71 – Richard Smith Protects GA consumers

from unexpected out-of-network costs incurred at an in-network facility

Typically occurs when contracted providers (anesthesiologists, radiologists) are out-of-network

Pharmacy Benefit Managers (PBMs) SB 103 and HB 276 Greater patient choice in

picking a pharmacy Restricting pharmacies from

offering delivery services Prohibits charging patients

more than pharmacies are reimbursed

Patients have a right to know if a cheaper generic is available

Protect the beneficial parts of the ACA:

No lifetime caps

No pre-existing condition exclusions

No exclusions for kids under age 26 to stay on their parent’s plan

Goals of Quality Health Reform

"NOW, I HAVE TO TELL YOU, IT'S AN UNBELIEVABLY COMPLEX

SUBJECT. NOBODY KNEW HEALTH CARE COULD BE SO

COMPLICATED."

Georgia Medicaid

Medicare Medicaid

For those age 65 and older (and those younger than 65 that have certain disabilities)

Administered and funded by the federal government

Based on financial need

Administered by state government using federal guidelines

Funded by federal and state dollars

Federal Funding for Georgia Medicaid

Based on the FMAP – “Federal Medical Assistance Percentage”

Georgia’s FMAP is 67.89% - for every dollar Georgia spends on Medicaid, the feds spend $2.11

Aged, Blind, and Disabled (ABD) Medicaid

Low-Income Medicaid (LIM)

Also known as Fee-For-Service (FFS) Medicaid

Managed directly by the state

Also known as the Georgia Families program

Patients are enrolled in Care Management Organizations (CMOs)

CMOs are paid a fixed monthly payment based on the number of patients they have enrolled

Two Main Types of Medicaid

CMOs

As of July 1, 2017:AmerigroupCareSourcePeach State Health PlanWellCare

Open enrollment March 1 – 31, 2017

S-CHIP

State Children’s Health Insurance Program For children age 18 and under (eligible until 19th

birthday) Family makes too much money to qualify for

Medicaid but not more than 247% percent of the Federal Poverty Guidelines

There is no cost for children under age 6. Monthly premiums are no more than $36 for one child and $72 for two or more children living in the same household. (plus co-pays for some services)

Georgia Department of Community Health (DCH)

Oversees Medicaid, S-CHIP, and the State Health Benefit Plan

About 1.87 million Georgians are enrolled in Medicaid and an additional 127,000 are on PeachCare

Provides healthcare to one in four Georgians Appoints members to the Drug Utilization Review

Board (DURB)

Drug Utilization Review Board

Promotes patient safety through an increased review and awareness of outpatient prescribed drugs.

Advises DCH about products considered to be the most clinically effective for members of Medicaid and PeachCare for Kids®.

Reviews drug therapy, drug studies and utilization information, thus enabling the Department to identify the most cost-effective policies for its members.

Preferred Drug List (PDL)

QUESTIONS?

Jeff CornettVice President of Research

and Public Policygjcornett@hog.org

Nichelle SimsAssociate Director of Research

and Advocacynpsims@hog.org